those that what i have has so far with what we have covered and so just in terms of letting you know and i want to know that part of the bill better than an of this bill so i can offer intelligent amendments. and you have given the assurance of time. real time to read the sections. you've been very good so far.

in making sure we have plenty of time to read what you've written and digest that and give it some thought and talk to people in our states about what's written. we don't have all the knowledge. we have to find out what the people in these fields think and be able to use that to offer and put up -- and also get our amendments scored. we can't have cogent amendments unless we have a score on cbo about what the amendments are going to do. so two days to accomplish all that i think is maybe -- i know it's what you want to do, but i think it's going to be very difficult to do. >> do you want to take a minute or so and just talk briefly about the amendment? >> i want to speak on procedure. >> yeah. >> this is a huge bill and it's being rushed on an head-long rate and on anything that's

substantive, the votes have been extremely one-sided. and key elements of this bill are blank. and even language which we received that you sent to cbo has not viability to it as to what it means. it's all so vague. and the thought that we're going to come back here and mark up something this mass i in two days that deals with government plan and employer mandates and potentially follow-on biologics, without even knowing what it's all about is becoming a game of hide the ball it seems to me. you know, clearly when senator mccain yesterday asked for some specifics on what you sent over to cbo to be scored i would have thought we would have gotten the specific proposals, not two or three sentences as to what you think patriot pose sals are.

fine, if you want to keep these proposals under wraps until you get a score, that's your right. but at least have the courtesy to recognize to jam us when we come back on these proposals on such big issues is inappropriate. >> i'm proceeding as i have proceeded. there will be ample time. you will not be confronted with conclusions that give you too brief a time to respond to them. basically we're making almost phone requests of cbo every time you change even a small number in terms of what you're asking them to evaluate. it takes them days to get back. so there's no a sophisticated elaborate submission. my colleague from new hampshire is more aware of this, having dealt with cbo for many more years than i have. we're trying to be flexible and

trying to get them to give answers because i want to present my colleagues with proposals that have scoring. i can't put out proposals and the first question is how does this score? if i can't answer that question, i'm charged with this is all about brings costs down as well as increasing access and quality. every time there's a proposal on the table, they've been scored. so i will not present you with anything that has not been scored and you have my word i will give all my colleagues ample opportunity to be able to review these matters as they come back. so certainly my intention would be even next week, judd, if we're able to get this stuff, get it to members to staff and others so even before we get back there's a time to review the matters before we reconvene on the 6th of july. in will be ample time. i said two days. it may take longer than that. those three issues are

complicated issues and i know the finance committee is grappling with those issues as well. not so much the follow-on biologics but the coast of the bill and the public options and the pay or play issues. that's the point i wanted to make. i was trying to get this much matter done, dealing with the matters we've dealt with over the last two weeks and the next day and a half or so if we can complete those. i'm happy to stay tomorrow, tomorrow afternoon and evening into friday to complete those. but my goal would be to get them done on the rest of the workforce, fraud and abuse and long-term care. i've got numbers for you on long-term care. >> we start july 13. just as it's important to prepare for this hearing, many of us on both sides of the aisle are going to have to be preparing for the judiciary committee. there are six members on jew

dish eyre that are going to be tied up in those hearings. >> all the more reason i hope we can complete our work when we get back before that all starts. i'm going to try to be as fair and open and stay as long as people want into the evenings and so forth to get the job done but i've got to get a job done here. >> can i clarify again. why do we have to get the job done in a hur tri? i'm trying to understand, why do we have to get the job done -- >> i'll tell you why. 14,000 people a day are losing their health care in this country. those who have health care, the costs are rising at an alarming rate. >> and this bill has 16 million people losing their health insurance. >> no it doesn't. that's an early prediction. uh we're trying to deal with those numbers. this is not sustainable. when you have people out there losing their insurance every day in a free fall, businesses are facing tremendous costs associated with it, this is a compelling issue for our country. for six decades we grappled with it. i'm not trying to force anything

down people's throats but i don't know if there's anything more important in my view than getting it right. it takes time, and i understand that. but i think the fact that we've been at this table for two weeks working on these issues, i think we've done a good job. we haven't agreed on everything, but we're getting there. i think this is important. i think it's worthy of our time and effort and i'm not going to try to race through it any more than i have over the last two weeks. but i'm determined to sit and work on our responsibility on this committee to fulfill that responsibility and have a product we can work with the finance committee and our colleagues. this is a first step in a long journey. we're not done here when we complete our bill. i realize there will be all sorts of ideas that will come along in this process. but i've got to complete my work and get this done and obviously i would have loved to have had completed all of it, but obviously that wasn't going to work and that's why i've tried to set out the agenda. >> mr. chairman? >> senator brown. >> i appreciate dr. coburn's question and i always appreciate

the comments he makes because they're genuine and thought through. i don't think you're doing this -- i think your amendments have been cogent and coherent and well stud did and well reasoned, but delay -- you know, this is something we've been working on for decades. i mean, we've worked on intensively on this legislation per say with what senator arkin is doing and mikulski and senator murray on each section. but we've been working intensively for months and years on these issues. we know these issues. we know how to discuss them, by and large how they're going to work. let's wait -- people say we shouldn't do health care now because the economy is so bad. but then when the economy is good, we shouldn't do health care because the economy is good. senator dodd, i think, has done this masterfully when, you know,

certainly not hurrying anything through their amendments, not hurrying anybody through their opens statements. i sat through a lot of opening statements in the house committee and i never quite heard such a marathon length of opening statements as we saw the other day. and senator dodd sat there as the chairman and did that right. and more importantly is the 14,000 people a day that lose health insurance. we don't want to rush this, but we're working very methodically and fairly and we need to do it. >> someone pointed out the other day, if all of us were sitting around the table and did not have health care coverage. we've got a great plan as federal employees, if we didn't have the kind of health care coverage, i suspect there might be a greater sense of urgency and a way to get this done. obviously none of us in this room including our staff and others who decided to take advantage of the health benefit package has to worry. if something happens to one of my daughters today, i have great coverage. but for many people in this

country, that's not where they are. and they worry as 80 million to 90 million people do at one point in the year who lose their health care coverage. what happens to one of their children if they get sick or need to be hospitalized or their spouse? and i know i can't solve that problem, even if we adopted a bill this afternoon because a lot of provisions don't kick in for a number of years. so i'm trying to suggest that somehow magically we're going to take care of everybody if we pass this bill. but it is a sense of trying to get this done. and i know my colleagues care about it and i know -- as mike enzi has said on numerous occasions, about 80% of what we're talking about, we agree on. i've dealt with a lot of legislation over 30 years here. that's rarely the case. we usually start with 20% we agree on. and the fact that we agree on 80% is a message we need to give to the american public. i'm convinced we're going to get this done, as members of this body, not as democrats or republican, but as united states senators.

we are going to get this done. i'm committed to it, i know mike enzi is. and we don't obviously agree on all these matters but you are always thoughtful, you know what you're talking about. you make a significant contribution and you've been with us virtually every day most of the time on these matters. and i want you to know i welcome that kind of participation as a newer member over the last several years. and judd greg and i have worked on countless issues over the years and i have great respect for him. i think virtually every one of you at one point or another we have worked on something together. i'm not going to rush anything on you. to try to get it done but i do want to keep working at it. if we could just hear on your amendment so we can move along. >> i will, but let me just express my concern. if we pass the wrong bill, if

we're not thoughtful and think about all the contingencies we're going to do, we neert going to help health care, we're going to hurt it. the presumption on this bill is we're going to spend according to president obama $1.3 trillion over the next ten years, add 8% to the cost of health care, add 8% to the cost of health care every year to, in fact, fix health care that doesn't fix it. i know you've got things -- we haven't seen it yet and i know the goals is to get the numbers to where it doesn't cost anything, but the fact is we're only going to get one shot. and then people are going to make decisions that are going to have tremendous ramifications and the worst ramification is to not do what president obama said he wanted them to do. if you got what you've got to do and you like it, you get to keep it. and we haven't even begun to consider the effects of what we've done already in this that's going to impact that. so speed is important.

i have a bill out there that does everything we do in this bill addressing the needs in the health care market. it's that i don't want to fix it. but the mistake washington just made with the stimulus plan in terms of, you know, what we said was -- employment wasn't going to be above 8%. now we're saying it's going to be above 10%. growth is going to come. no it isn't. we don't know what we don't know. to say speed is the most important thing rather than quality on the biggest segment of our economy that impacts every person, every individual in this country is going to be impacted by this bill. >> speed is not the most important. >> i want us to get a bill this year. i want it to be the right bill. i want us to fix it. i have a whole lot of different views than my colleagues on the other side of the aisle. i'll express those when we get to the floor if i haven't expressed them here. but just like this amendment,

and i'll go to this amendment, we're increasing spending $4 billion. we're increasing 20 new programs. the federal government is the only area in the world right now that's had increase employment. added 67,000 efederal employees in the first six month ofgs this year and this bill does nothing but add a whole bunch more employees. so the idea is -- we already have a structure out there. we have 200 time where is we're going to tell the bureaucracy what they're going to do and we've got built in, in every state the ability to handle everything that we want to accomplish and give them the freedom to do it. and what this amendment does is say let's put the responsibility on the states and then let's do the oversight to see that they do it right. >> a good debate before lunch on this. i think senator harkin pointed out despite my friend from oklahoma's description of the bill as the president has drafted, the states are paramount and are considerations in this. and that's intention, all of us, to make sure that's the case.

let's move on. do you want a roll call vote on this? rr'@ @ kák @ @ @ @ @ n @ @ @/

are agreed on by both sides and i would ask unanimous consent that they be approved. >> i ask by consent those two amendments be agreed to without objection. they are agreed to. that now brings to about 25 of those amendments have been either agreed to or we've disposed of. senator binghamton? >> thank you very much, mr. chairman. i wanted to bring up bing ha hafr -- binghamton amendment number two. this is to train health care professionals in existing, in a

matter that emtzs team-based service, emergency preparedness and response.s team-based service, emergency preparedness and response.ms team-based service, emergency preparedness and response.ps team-based service, emergency preparedness and response.hs team-based service, emergency preparedness and response.as team-based service, emergency preparedness and response.s team-based service, emergency preparedness and response.is team-based service, emergency preparedness and response.s team-based service, emergency preparedness and response.es team-based service, emergency preparedness and response.s tead service, emergency preparedness and response. team-based service, emergency preparedness and response.zs team-based service, emergency preparedness and response.es team-based service, emergency preparedness and response. they are our first line of defense against swine flu and food-born salmonella and health threats of natural dezaires such as what we saw with katrina and rita. the epa, the coast guard, the indian health service, just to name a few. despite their vital role, the commissioned core faces a work shortage. in the last year alone, the number of physicians serving as

public health service officers declined by 5%. the dental officer core has lost one fourth of its workforce in the last six years. the pharmacy and nursing corps face similar workforce shortages. so given this need, the creation of this public health sciences track has been strongly endorsed by the commissioned officers association of the u.s. public health service. and this committee, senator kennedy has received a letter from former surgeon general c. everett coop urging us to include this provision in the health reform package. i introduce this bill, or these provisions as a free-standing bill earlier this year, several months ago. students in the public health see sciences track will receive a

tuition stipend. they're accepted as commissioned corps officers with a two-year service commitment or each year of school, the cost is covered by the pipeline. it's analogous to what the department of defense reserve officer training corps has done for decades in preparing students to become military officers. i would urge my colleagues to support the amendment. >> is there further discussion on the bingaman amendment? >> mr. chairman, i just want a minute to scan through it. >> certainly. >> i'm not sure why this wasn't

done to an earlier title why we're moving it to this spot, i guess that would be one of my questions. but this is another new program that we're ed auding and i notice it doesn't wind up with any score because it's just authorized. that leaves a pretty big hole that we're not going to cover at all. >> jeff, do you want to respond to this? >> it's being offered here because it's part of the workforce training provisions. and i was told this was the proper place to do it. you're exactly right. it does accomplish a new program but it strictly authorizes the establishment. it does not appropriate funds. there's no automatic funding provided for this. >> any idea, jeff, on the terms of what the estimated cost were to be if it was fully appropriated at the fully

authorized level? >> i don't have that at this point. it would depend, we say, such sums as are appropriated. the numbers we're talking about here, this is not an enormous undertaking. the legislation calls for the program to be organized so as to graduate 150 medical students annually. 100 dental students annually. 250 nursing students annually. 100 public health students annually. 100 behavioral and mental health students annually. 100 physical assistant or nurse practitioner constitutions annually. and 50 pharmacy students. so it's a relatively modest addition to the work force if it

were fully funded. and as i say, it would be up to the approapriations committee hw much to fund. >> about 1,000 students annual sflie. >> about 1,000 students in all these different disciplines. >> further comments on this proposal? >> just a question or clarification for the sponsor here. this track is located at existing and accredited health profession education training program at various academic centers. so it's yet to be determined what medical schools these tracks may be established in. but i'm assuming that with the programs that we're talking about, whether it's dental or nursing or behavioral or mental health that in these existing

medical schools we already ah have these programs. are we setting up something separate and apart from these existing facilities and how does this integrate? >> what we're trying to do is set up a program that would operate similar to the rotsi program. and that would basically have -- just as the department of defense provides financial assistance to students to go through and get training in particular areas and then go into the military for a certain period of time, this does the same thing with regard to these health professionals. it tries to encourage students to pursue careers in these fields in return for which they get their tuition paid and they get a stipend to assist them with the cost of their

education. and then for every year that they obtain this stipend and tuition payment, they're committed to a two-year period of service with the public health service. so it's a way to fill the pipeline and to get an adequate number of people come into the public health service to perform the duties of the public health service. >> so it correct that this education would be provided for them contingent upon two years in the public health service? >> for each year that they obtain the financial support contemplated in here, they have to commit to two years of service. so if they had four years of

college in nursing or training in nursing they would be committed to work for the public health service for an eight-year period, the way i understand it. >> tom? >> there's no question we have a significant shortage in the commission corps and we have really dedicated people, no matter what aspect of it they're working. jeff, you weren't here earlier, but i think this fixes the wrong problem again. if we would pay commission corps officers comparable to what they're worth and comparable to the private sector we wouldn't have trouble getting people to go into the commission corps. and so again we're treating the cough with a narcotic to suppress the cough and some tylenol for the fever but we're forgetting to feed the pneumonia and give the antibiotic. that's an economic enducement to go in. if you get them there for eight

years and then they leave because we're not paying, you may have gotten eight years of coverage, but some of our best commissioned officers are the ones that have years of experience there and have dedicated their whole life to that cause. and our goal ought to be to get them in and get them to stay. and the only way we're going to do that is to pay them properly. even if you look at their pay. we talked about primary care earlier, we don't come close to paying our commissioned corps officers what they could make in the private sector, even compared to primary care. and so i think we got to -- when you come out with the other portion of this bill, you've got to have payment in there to make it equitable so that you can draw people into the commissioned public health corps. this fixes the symptom but it doesn't fix the disease. and i would tell you, my opinion, and it's just mine -- i found that out, my opinion is 0

10/23 of this committee, if we would change the pay instead of this program you wouldn't have any trouble getting people going into the commissioned corps. but if you don't have the pay we're going to lose the experience they gained for eight years and then they're going to go somewhere else. what we don't want is turnover in the commission corps. if we get them we ought to pay them. if we pass this amendment, let's please put the proper payment in for commissioned corps officers and pay them what they're worth. >> let me just respond. i agree with a lot of what you're saying. this does a couple of things. first, it's an enducement for people to pursue these types of careers. it says to a student look, we'll underwrite a lot of the costs of you getting an education if you're pursue this type of

career rather than a different type of career. i think that's positive. i don't think that's just giving them tylenol. i think that's a positive statement. and then it does lock them into working for the for the public health service for a period of time in this commissioned corps, which again sing a positive in itself. and a lot of them knowing how way leads on to way, people wind up sometimes at least staying in the careers that they begin working in. and staying in the jobs they begin working in. your point we're not paying these folks enough, i agree with. and i'll support if you have an amendment to that effect or something you want to propose to better pay the public health service officers. i'll support that. >> if i may, i think you'll see

that. >> good, i think that's a good thing to do. >> what happens if they do this and then say they don't want to fulfill the obligation. it's not addressed in your amendment. >> i assume we'll deal with it the same way we deal with rotsi, if people decide they don't want to stay in. yeah, we leave that to the secretary to decide by regulation, i guess, what course to follow if someone reneges on their obligation. >> the reason that's confusing because we have very specifically talked about the other student loan where is we are helping them and we have specific rem disfor people who don't. we need to get some coherence here. >> and this is not a loan. >> this is a grant. you're going to be endenturedo